Descending thoracic aortomyoplasty: A technique for clinical application

• Published in: The Annals of thoracic surgery Vol. 61; no. 1; pp. 93 - 98
• Main Authors: Flum, David R., Cernaianu, Aurel C., Meada, Riad, Lee, Laura A., Salartash, Khashayar, Grosso, Michael A., Weiss, Richard L., Cilley, Jonathan H., DelRossi, Anthony J.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 1996; Elsevier Science
• Subjects: Animals; Aorta, Thoracic - diagnostic imaging; Aorta, Thoracic - surgery; Assisted Circulation; Biological and medical sciences; Cardiomyoplasty; Electric Stimulation; Electrocardiography; Goats; Hemodynamics; Male; Medical sciences; Muscle, Skeletal - transplantation; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Ultrasonography, Interventional; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Intensive cardiocirculatory care; Cardiocirculatory support; Cardiovascular disease; Descending aorta; Latissimus dorsi muscle; Result; Plasty; Instrumental stimulation; Vertebrata; Mammalia; Treatment; Surgery; Animal; Goat; Artiodactyla; Technique; Left ventricle performance; Ungulata
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/0003-4975(95)00825-X

Descending thoracic aortomyoplasty is a form of skeletal muscle-powered cardiac assistance. Its use in clinical settings has been limited by the ligation of intercostal arteries necessary to complete a circumferential wrap of the aorta with the latissimus dorsi.
This study messed the feasibility and the efficacy of aortomyoplasty constructed with a modified latissimus dorsi. A pericardial patch was attached to the latissimus dorsi and divided around the preserved intercostal arteries. Nine alpine goats (37 ± 2 kg) underwent descending aortomyoplasty using this technique. All intercostal arteries were preserved. After a 6-week recovery period, the animals underwent a 6-week, incremental electrical conditioning program. After 90 postoperative days, animals were examined under anesthesia with the myostimulator on and off.
Aortomyoplasty activation resulted in augmentation of mean diastolic aortic pressure by 16.0 ± 0.9 mm Hg (23%). Significant improvements in cardiac index (40%), stroke volume index (37%), left ventricular stroke work index (49%), and mean arterial pressure (19%) were noted. An intravascular sonographic probe placed in the descending aorta revealed circumferential compression of the aorta during counterpulsation. Mean cross-sectional aortic area was reduced by 51.8%, from 210.1 ± 7.1 to 108.9 ± 6.7 mm
2 during aortomyoplasty activation (
p < 0.05). Histologic analysis confirmed the long-term patency of intercostal arteries.
Descending aortomyoplasty, modified with an interposing patch of pericardium, effectively transfers skeletal muscle force across the aortic wall and assists cardiac function. This technique allows preservation of all aortic branches, and with this novel approach, the clinical utility of aortomyoplasty can now be explored.